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Community Health Worker

SUMMARY:

Full time Community Health Worker (CHW) at the Lynn Community Health Center (LCHC) needed to provide community and health center based support for LCHC high risk, and complex patients.

The Community Health Worker (CHW) at the Lynn Community Health Center (LCHC) is part of an integrated and interdisciplinary care team working to address patients’ health needs. The community health worker will provide culturally appropriate individual and group health education, coaching, informal counseling, case management, care coordination, and advocacy in order to promote, facilitate and improve access to ongoing primary and behavioral health care for members of the target population. The community health worker works with interdisciplinary care teams and other providers, as appropriate to promote, maintain, and improve the patient’s health.

The primary responsibility of the community health worker is to educate, advocate and coach patients who require additional support to meaningfully address medical, social, and psychological needs. The patient’s behavioral /primary care provider takes the lead role in devising patient centered treatment or action plan(s) and identifying focus areas for the community health worker to work with the patient. The community health worker collaborates closely with the provider, nurse care manager, team nurse manager, and other members of the interdisciplinary care team. The community health worker works with the patient in clinic and community settings, as well as the patient’s home.

Additionally, the Community Health Worker participates in LCHC community outreach efforts, as appropriate and as assigned. This may include participating in health screenings, health education programs or counseling at health fairs and other similar community events. The Community Health Worker also plays an important role in the community on behalf of patients to provide assistance with skill building, facilitating linkages with other community based and natural support systems, and advocating for community needs.

Conduct outreach and engagement activities that support patient continuity of care, including re-engaging patients in care if they miss appointments and/or do not follow up on treatment.

Conduct an initial and periodic needs assessments, including assessing barriers and assets (e.g. transportation, community bariers, social supports); patient and family or caregiver preferences; language, literacy and cultural preferences.

Promote patient treatment adherence through assessing patient readiness to make changes, assisting patient in making changes in daily routines, identifying barriers and assisting patients with developing strategies to address barriers.

Meet face-to-face with patients according to frequency agreed upon by patient, supervisor, and interdiciplinary care team. Provide other support and follow up via telephone or mail contact as necessary.

Collaborate with other providers, staff and community resources to enhance coordination, quality and efficiency in care.

escort patients to pharmacy; grocery store; food pantry and other community locations as needed to meet goals of treatment/care plan

Network/collaborate with community leaders, area health providers, voluntary organizations and others who can contribute to ongoing assessment of the health needs of the target population.

Conduct community outreach to

provide information/make referrals to/coordinate needed services

identify community resources that provide needed support for patient

provide health education to individuals and groups on prevention and public health risks and problems

educate staff/providers about target population and community characteristics and needs

Participate in meetings with supervisor and attend team and staff meetings at the health center.

Participate in staff development trainings and external educational offerings to maintain and improve knowledge base.

Accurately document all patient interactions in a timely fashion in the designated electronic health record. Documentation includes but not limited to: care plan progress, telephone calls, home visits, time with providers, case management, travel time etc.

Keep logs, data on patient contacts, as required by funding source.

Requirements

EXPERIENCEANDTRAINING:

Three or more years experience as a community health worker or case manager in a community health setting; and/or related experience in health/human services, social services or advocacy.

Ability to openly address and acknowledge issues of addiction, substance use and mental illness.

Training and or certification as a community health worker preferred. Community health worker should obtain certification within one year of Massachusett’s Department of Health certification approval and or within six months of hire, whichever comes first.

Lynn Community Health Center (LCHC) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, LCHC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation and training. LCHC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of LCHC’s employees to perform their job duties may result in discipline up to and including discharge.